M.D. Licensing Hurdle

Licensing of foreign-trained doctors in California can be a long and expensive process. Even if they have gone through internship, licensing and residency in their native countries, they must go through the following procedure before they are allowed to practice in the state.

Foreign-trained doctors must first take a three-part test called the Foreign Medical Graduate Examination in the Medical Sciences, which covers English proficiency, basic sciences and clinical competency.

If they pass, they then take the first part of the nationally recognized Federation Licensing Examination (FLEX), a written examination required of all graduates of foreign medical schools. The FLEX exam is equivalent to the National Board of Medical Examiner’s examination taken by most graduates of U.S. medical schools. If they pass, they are permitted to begin a minimum one-year internship.

In some states outside California, graduates of foreign medical schools--even if they are American citizens--must complete an additional one, and sometimes two, years of postgraduate training.


To obtain licenses after their internship, graduates of foreign medical schools, must then pass the second part of FLEX and a 15-minute oral examination.

Private preparatory courses cost $3,000 to $5,000. In addition, testing fees range from $320 to more than $500 for each examination.